Rezum™ Water Vapor Therapy is a minimally invasive surgical treatment that uses convective water vapor thermal energy to treat benign prostatic hyperplasia (BPH). Current guidelines recommend Rezum for patients with prostates less than 80 grams, but little data exists describing outcomes in patients with prostates greater than 80 grams.

Michael A. Palese, MD, Professor of Urology at the Icahn School of Medicine at Mount Sinai and Director of Minimally Invasive Surgery, along with his team, evaluated the use of Rezum technology for prostates greater than 80 grams. Their findings were published in World Journal of Urology in January 2021.

Outcomes were documented at preoperative, short-term (S-T, <3 months), and long-term (L-T, >3 months) postoperative follow-up, including peak flow (Qmax), post-void residual (PVR), AUA-Symptom Score (AUA-SS), medication usage, catheterization, and postoperative complications.

Thirty-six patients (or 16.9% of all Rezum patients) met inclusion criteria. Mean baseline prostate size was 106.8 grams. Postoperatively, statistically significant improvements in Qmax (L-T: 7.4 to 14.7, p=0.039) and PVR (S-T: 161.1 to 89.2, p=0.022; L-T: 161.1 to 63.3, p=0.004) were noted.

Patients with longitudinal follow-up also exhibited, on average, significant improvements in Qmax (S-T: +9.6, p=0.003; L-T: +11.0, p=0.017), PVR (S-T: -71.9, p=0.012; L-T: -77.3, p=0.003), and AUA-SS (S-T: -8.2, p=0.043).

After one year, alpha-blocker usage decreased significantly (p=0.002); 5-alpha reductase inhibitor, antispasmodic, and phosphodiesterase-5 inhibitor usage and self-catheterization rates remained unchanged. Mean time to Foley catheter removal was nine days postoperatively. Postoperative complications were minor. Only three patients (8.3%) required retreatment.

“In patients with large prostates, Rezum safely and effectively provided short-term and long-term symptomatic relief as well as durable improvement in voiding function,” said Dr. Palese. “Further efforts will explore the possibility of expanding inclusion criteria for Rezum as well as monitoring sustained symptomatic relief.”

After one year, alpha-blocker usage decreased significantly (p=0.002); 5-alpha reductase inhibitor, antispasmodic, and phosphodiesterase-5 inhibitor usage and self-catheterization rates remained unchanged. Mean time to Foley catheter removal was nine days postoperatively. Postoperative complications were minor. Only three patients (8.3%) required retreatment.

“In patients with large prostates, Rezum safely and effectively provided short-term and long-term symptomatic relief as well as durable improvement in voiding function,” said Dr. Palese. “Further efforts will explore the possibility of expanding inclusion criteria for Rezum as well as monitoring sustained symptomatic relief.”